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Study Hints Antidepressants May Help after Heart Attack

Breaking News - July 2005 - Week 2

(Jul 13, 2005)

Healthcare in  the News

-- A study intended to see if psychotherapy could help heart attack patients who suffer from depression has instead shown that antidepressant medication improves survival, according to a study reported in the Archives of General Psychiatry.

A picture of a man preparing food in a kitchen

In depressed patients who have experienced a heart attack, use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), was associated with a reduced risk of death and recurrent heart attack, the researchers find.

While psychotherapy had little effect, an antidepressant drug reduced the risk of death or a second heart attack by 43 percent, the researchers say.

"Our study provides much stronger evidence than we've ever had before that antidepressants are safe and may benefit these patients," says Dr. C. Barr Taylor, professor of psychiatry and behavioral sciences at Stanford University School of Medicine, and lead author of the report.

Depression May Follow Heart Attack

Cardiovascular disease (CVD) is the leading cause of death, major disease, and disability among US men and women, the researchers say.

Major depression was found in about 20 percent of patients with a recent myocardial infarction (MI, or heart attack). A similar prevalence was found for minor depression.

Depression is a risk factor for recurrent non-fatal heart attack and cardiac death in patients who experience an acute MI (AMI), independent of cardiac disease severity, the researchers explain.

Despite their effectiveness in treating depression, the use of antidepressants in patients with CVD remains controversial.

The incidence of depression among people who suffer a heart attack is high. A report issued in May by physicians at the Johns Hopkins University School of Medicine found that one of every five heart attack patients suffers from depression.

"This hasn't been generally recognized by cardiologists," said Dr. Richard Lange, chief of clinical cardiology at Hopkins. "That is why this report was needed to examine the issue."

But even though a previous study produced similar evidence of the beneficial effects of antidepressants after a heart attack, the new finding may not translate directly into clinical practice, says Dr. Alexander H. Glassman, professor of psychiatry at Columbia University, who wrote an accompanying editorial in the journal.

Dr. Glassman says only the most depressed patients, those known to be at higher risk for cardiac events, were offered antidepressants. In addition, he says, there was no control over when the medication was started or stopped, and even the reported start and stop times were only estimates.

"However, the sample was large, the number of events reasonable, and the magnitude of the effect is hard to ignore," Dr. Glassman says.

The flaw in the new study is that it was not originally designed to examine the effect of antidepressant treatment, Dr. Glassman explains.

Instead, nearly 2,500 patients were divided into two groups, one getting psychotherapy and one receiving only antidepressants.

The analysis looked at the 28 percent of patients in the therapy group and the 20 percent of those in the nontherapy group who were given antidepressants called selective serotonin reuptake inhibitors because of the severity of their depression, Dr. Glassman says.

Dr. Glassman was also a leader of the previous study, done in 2002, which also treated depressed heart patients with Zoloft®. It, too, was insufficient to change the standard of care because it included only 369 patients, not nearly enough to provide statistically significant evidence of benefit, he says.

"The truth is that this will not be made a standard of care unless you have definitive evidence," Dr. Glassman emphasizes.

Such proof would come only from a large-scale study involving perhaps thousands of people diagnosed with depression after a heart attack, he says. But no such trial is in sight, Dr. Glassman adds.

Evaluation for Depression Needed

Should cardiologists routinely give such patients an antidepressant?

"At this point, a clinician has to use his judgment," Dr. Glassman says. "There is not enough evidence to mandate what physicians should do."

In his practice, Dr. Lange says, "I try to ascertain if a patient has evidence of depression. If there is evidence of depression, I offer use of an antidepressant, usually in collaboration with a psychiatrist."

Recently, the US Food and Drug Administration (FDA) issued a second warning that people taking selective serotonin reuptake inhibitors may be at greater risk of suicidal behavior.

The agency recommended that adults being treated with antidepressants, particularly those being treated for depression, should be watched closely for worsening of depression and for increased suicidal thinking or behavior.

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Heart Association

Centers for Disease Control and Prevention (CDC)

Institute of Medicine

National Heart, Lung, and Blood Institute

National Institute of Mental Health

National Institutes of Health (NIH)

National Library of Medicine

US Food and Drug Administration (FDA)

For more information on health and wellness, please visit health information modules on this Web site.

Overview of Depression

Depression is a disorder that involves a person's body, mood, and thoughts.

It can affect and disrupt eating, sleeping, or thinking patterns, and is not the same as being unhappy or in a "blue" mood, nor is it a sign of personal weakness or a condition that can be willed or wished away.

People with a depressive illness cannot merely "pull themselves together" and get better.

Treatment is often necessary and many times crucial to recovery.

There are three primary types of depression, including major depression (clinical depression); manic depression (bipolar disorder); and dysthymia (dysthymic disorder - a less severe, but more chronic form of clinical depression).

The following are the most common symptoms of major depression. However, each individual may experience symptoms differently. Symptoms may include:

  • persistent sad, anxious, or empty mood
  • loss of interest in activities once previously enjoyed
  • excessive crying
  • increased restlessness and irritability
  • decreased ability to concentrate and make decisions
  • decreased energy
  • thoughts of death or suicide, or suicide attempts
  • increased feelings of guilt, helplessness, and/or hopelessness
  • weight and/or appetite changes due to over- or under-eating
  • changes in sleep patterns
  • social withdrawal
  • physical symptoms not improved by standard treatment (i.e., chronic pain, headaches)

For a diagnosis of major depression to be made, an individual must exhibit five or more of these symptoms during the same two-week period.

The symptoms of major depression may resemble other psychiatric conditions. Always consult your physician for a diagnosis.

NIMH Summary on Heart Disease and Depression

Research over the past two decades has shown that depression and heart disease are common companions and, what is worse, each can lead to the other, according to a statement by the National Institute of Mental Health (NIMH).

It appears now that depression is an important risk factor for heart disease along with high blood cholesterol and high blood pressure.

A study conducted recently found that of 1,551 people who were free of heart disease, those who had a history of depression were four times more likely than those who did not to suffer a heart attack in the next 14 years, the NIMH states.

In addition, researchers found that heart patients who were depressed were four times as likely to die in the next six months as those who were not depressed.

Depression may make it harder to take the medications needed and to carry out the treatment for heart disease, states the NIMH.

Depression also may result in chronically elevated levels of stress hormones, such as cortisol and adrenaline, and the activation of the sympathetic nervous system (part of the "fight or flight" response), which can have deleterious effects on the heart.

In addition to antidepressant medications, other treatments have been shown to reduce both depression and risk of heart disease.

For example,a recent study found that participation in an exercise training program was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression. Exercise, of course, is a major protective factor against heart disease as well.

Always consult your physician for more information.

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